Summary

The authors analyse the different causes of the underassessment of pain in child which can account for an relative negligence in therapeutic attitude. Multiple factors are involved and the authors insist upon the diagnostic value of pain explaining a rather respective attitude, the relative ignorance of pain physiology up to recently, the unprecise definition of «childhood» which includes prematurity, neonatal period, infancy, adolescence and so on… Two false concepts have also to be reviewed, an alleged anatomic inaptitude related to an insufficient myelinisation and/or alow density in pain receptors…, an alleged functionnal incapacity due to a lack in one or several neurotransmitters… The more recent biocheminal data would rather indicate a deficit in central pain control (descending pathways, opioïd systems). So the child suffers perhaps more than the adult does although on a different mode; the pain integration is vegetative at first, behavioral and cognitive lately, therefore a specificity of pain expression in infancy in the absence of verbal communication. Authors conclude recalling the role of pain in central nervous system maturation.